Step 2 Factoids S

Front 1

most accurate test for antiphospholipid sundrome and lupus anticoagulant

Back 1

russel viper venom

Front 2

first test

Back 2

mixing study

Front 3

definitive test for lupus nephritis

why done?

Back 3

kidney biopsy

to figure out which kind and severity

Front 4

tx for glomerulosclerosis

Back 4

None

Front 5

tx for mild hephropathy

Back 5

ST steroids

Front 6

tx for proliferative nephropathy

Back 6

steroids
mycophenolate (best) or cyclophosphamide

Front 7

protein/Cr ratio tells you same info as

Back 7

24 hour urine

Front 8

captopril lnuclear renogram is a

Back 8

renal artery stenosis test

Front 9

sudan black stain

Back 9

fat malabsorption test (celiac + other)

Front 10

what kind of glomerulonephrtiis happens in lupus

Back 10

membranous

Front 11

Nil Lesion

Back 11

fusion of foot processes (in minimal change)

Front 12

lung finding in lupus

Back 12

alveolar hemorrhage

Front 13

bronchiectasis associated with

Back 13

CF
Kartejeners

Front 14

what teset determines disease activity

Back 14

1) complement levels (because used up in chronic infection)
2) anti DS will also go up

Front 15

how can you tell an ophthalmoscopic pic is veinous

Back 15

blood got in but can't get out

Front 16

typical eye problem in lupus

tx?

Back 16

retinal vein occlusion

none

Front 17

ophthalmoscopic
difusely pale
red blotch

Back 17

optic neuritis

Front 18

blurry borders around optic nerve

Back 18

optic neuritis

Front 19

2 causes of sudden stroke in lupus

Back 19

libman sacks emboli
lupus anticoagulant

Front 20

how to test if liebman sacks was cause

Back 20

echo

Front 21

most common murmur in lupus

Back 21

MR

dilation
also maybe AR

Front 22

pansystolic murmur

Back 22

MR

Front 23

sharp tennessee murmur

Back 23

MS

Front 24

crescendo decrescendo murmur

Back 24

AS

Front 25

what is pathophys of drug induced lupus

Back 25

acetylation irregularity

Front 26

best test for Meckels

Back 26

technetium scan

Front 27

cuase of meckels

Back 27

incomplete obliteration of pmphalomesenteric duct

Front 28

systeolic ejection murmur at R 2nd intercostal space

Back 28

aortic stenosis

Front 29

systeolic ejection murmur and bleeding mixed in stools without pain

Back 29

suspect angiodysplasia

Front 30

pt bleeding heavily
whole blood or PRBCs?

Back 30

PRBC because of added O2 carrying capacity

Front 31

what nexus of genetic disorders is zollinger ellison a part of?

enterhohepatic tumors?

Back 31

men 1

Front 32

flushing
valvular disease
dirrhea

Back 32

carcinoid

Front 33

deficiency in carcinoid

Back 33

niacin

Front 34

precaution in pregnancy with lupus

Back 34

control anti Ro

Front 35

if baby ant Ro +

Back 35

cardiac defects such as
3rd degree block

Front 36

what percent of lupus pts are anti Ro?

sjogrens pts?

Back 36

30-50% in lupus
90% in sjogrens

Front 37

tx for drug induced lupus

Back 37

stop the drug

Front 38

thickened gallbladder wall

Back 38

acute cholecystitis

Front 39

prominent gastric folds
ulcer beyond duodenal bulb

dx?
if not diagnostic?
why?

Back 39

zollinger ellison

serum gastrin >1000

secretin stimulation

secretin inhibits normal cells gastrin secretion BUT increases gastrinoma secretions

Front 40

TFTs in hashimotos

Back 40

TSH increased
T4 decreased
+ TPO antibodies

Front 41

estrinism and decreased TFTs

Back 41

liver disease

Front 42

which comes first, breast feeding or breast milk jaundice

tx

Back 42

feeding

increased feedings

Front 43

dark brown discoloration of colon

Back 43

factitious diarrhea from laxatives

Front 44

cuases of erythema nodosum

Back 44

syphillis
sarcoid
strep
pregnancy

Front 45

GI disorder associated with erythema nodosum

Back 45

IBD

Front 46

test for c diff

Back 46

cytotoxin assay

Front 47

somatic or visceral points?

Back 47

somatic points

Front 48

cirrhosis
ascites
fever

Back 48

spontaneous bacterial peritonitis

Front 49

typical cause of pancreatitis in a non-alcoholic

Back 49

gallstones

Front 50

painless rectal bleeding in 20 mos old

Back 50

meckels

Front 51

estrinism and decreased TFTs

Back 51

liver disease

Front 52

which comes first, breast feeding or breast milk jaundice

tx

Back 52

feeding

increased feedings

Front 53

dark brown discoloration of colon

Back 53

factitious diarrhea from laxatives

Front 54

cuases of erythema nodosum

Back 54

syphillis
sarcoid
strep
pregnancy

Front 55

GI disorder associated with erythema nodosum

Back 55

IBD

Front 56

test for c diff

Back 56

cytotoxin assay

Front 57

somatic or visceral points?

Back 57

somatic points

Front 58

cirrhosis
ascites
fever

Back 58

spontaneous bacterial peritonitis

Front 59

typical cause of pancreatitis in a non-alcoholic

Back 59

gallstones

Front 60

painless rectal bleeding in 20 mos old

Back 60

meckels

Front 61

initial tx for chronic hep c

Back 61

interferon and ribavirin

Front 62

initial tx for chronic heb P

Back 62

interferon and lamivudine

Front 63

initial tx for chronic mild hep C

Back 63

interferon alpha only

Front 64

hep tp who had multiple infusion prior to 1982. test for?

Back 64

hep B+C

Front 65

femail at 25 wks diagnosed with hep C. Next step

Back 65

A+B vaccines

Front 66

most likely ause of pancreatitis in non alcholoic, normal lipid, healthy woman

first diagnositc step

Back 66

gallstones

u/s

Front 67

diagnosis of pancreatitis

Back 67

CT

Front 68

non surgical tx for cholelithiasis

Back 68

ursodeoxy

Front 69

non tender but palpable gallbladder at RCM with janudice

Back 69

courvoisier's sign of metastatic disease

Front 70

virchows node

Back 70

metastatic

Front 71

virchow's node

Back 71

metastatic disease

Front 72

chronic hep with saxing/waning transaminases and arthralgias

Back 72

c

Front 73

heb c associations

Back 73

Cryoglobulinemia (gn)
B cell lymphoma
plasmocytosis
Sjogrens et al
Lichen planus
porphyria C+
ITP

Front 74

fecal fat in diarrhea
Causes

Back 74

bacterial overgrowth
pancreatic insufficiency
celiac
crohns

Front 75

impaired d xylose absorbtion
- improves after abx
vs
- does not improve after abx

Back 75

bacterial overgrowth

celiac

Front 76

cryoglubulinemia results from

Back 76

chronic hep c

Front 77

heavy lymphocytic infiltrate in portal traces

inflammatory, granulomatous destruction of small/medium intrahepatic biliary ducts

Back 77

PBC

Front 78

diagnosis of chronic hepatitis

Back 78

biopsy

Front 79

diagnosis of acute hepatitis

Back 79

LFTs

Front 80

continued pain after chole

tx?

Back 80

functional pain

analgesics and reassurance

Front 81

dyspepsia and bloating after medsRUQ pain
increased shoulder opain occasionally
esp after fatty meal

dx

Back 81

cholelithiasis

u/s

Front 82

when is u/s best diagnostic first step

Back 82

cholelithiasis
cholecystitis
choledocholithiasis

Front 83

deficiency that predisposes to anaphylaxis in blood transfusion

Back 83

IgA

Front 84

fastest reaction to blood transfusion

tx

Back 84

anaphylaxis

IVF
epinephrine
vasopressors

Front 85

travel to endemic area e.g., Mexico
dysentery
RUQ pain
single cyst in R lobe

dx
tx

Back 85

amebiasis

stool exam
metronidazole

Front 86

abd pain
L pleural effusion

Back 86

pancreatitis

Front 87

most common cause of ascites and pedal edema

Back 87

chronic viral infection

Front 88

middle aged woman
pruritis
fatigue
xanthelasma

tx

Back 88

PBC

ursodeoxy

Front 89

anti smooth muscle abs

Back 89

acute and chronic hep

Front 90

anti smith abs

Back 90

SLE

Front 91

anti LKM (liver kidney) abs

Back 91

acute and chronic hep

Front 92

pANCA

Back 92

churg straus
m poly
PSC

Front 93

solitary liver mass in young/middle aged woman
+ OCP use
increased alk phos and GGT

diagnosis
next step
tx

Back 93

hepatic adenoma
imaging NOT biopsy 2/2 bleed risk
resection

Front 94

liver biopsy with
sinusoids
kupffer cells

Back 94

focal nodular hyperplasia

Front 95

liver tumor with central necrosis
large multinucleated anaplastic cells

Back 95

primary hepatocellular carcinoma

Front 96

tx for dubin johnson

Back 96

none required

Front 97

pANCA +
jaundice

Back 97

PSC

Front 98

liver disease with
jaundice
associated with UC

Back 98

PSC

Front 99

increased alk phos
increased bilirubin
AST,ALT <300

Back 99

PSC

Front 100

cholangiography shows
multifocal structures
dilatation
beading of bile ducts

Back 100

PSC

Front 101

tx for PSC

Back 101

urso
BUT only transplant is definitive

Front 102

mechanism of Reye's

Back 102

difuse mitochondrial injury

Front 103

extensive fatty vacuolization o fliver

Back 103

reyes
alcoholic

Front 104

increased AST/ALT
increased ammonia
PT prolongation
hypoglycemia
metabolic acidosis

Back 104

Reyes

Front 105

ballone degneration with PMN infiltrates

Back 105

acute alcholic hepatitis

Front 106

panlobular mononuclear infiltration with hepatic cell necrosis

Back 106

acute viral hepatitis

Front 107

bridgning necrosis

Back 107

acute and chronic viral hep

Front 108

patient with
acute pancreatitis leading to
hypovolemic shock

tx

Back 108

capillarly leak from enzymes

IVF

Front 109

flak and /or periumbilic ecchymoses

Back 109

gray turner and/or cullin's signs for severe retroperitoneal hemorrhage

Front 110

increased ALT>AST
leading to increased bilirubin and alk phos

Back 110

acute hepatitis

Front 111

new onset oliguria


first step

Back 111

check foley

Front 112

new onset oliguria
foley ok
prerenal azotemia found

next step

Back 112

careful fluid challenge

Front 113

tx of newborn of pregnant woman with active Hep B

Back 113

HBIG passive immunization at birth
vaccination with recombinant HBV vaccine

Front 114

decreased quantitiy of bile ducts (ductopenia)

Back 114

PBC

p BCDuct

Front 115

mallory bodies
hepatocyte swelling and necrosis

Back 115

alcoholic hepatitis

Front 116

periductal portal tract fibrosis
segmental stenosis of extrahepatic and intrahebatic bile ducts
connective tissue deposits in onion skin pattern

Back 116

PSC

Front 117

unusually dark urine
scleral icterus
jaundice
+ bilirubin in urine dipstick

Back 117

conjugated hyperbiliruinemia

= rotor or other

Front 118

conjugated or unconjugated?
rotor
hemolytic anemia
thalassemia
PNH

Back 118

conjugated
unconjugated
unconjugated
unconjugated

Front 119

icteris
mild uncon bilirubinemia
malaise
fatigue

Back 119

gilberts

Front 120

conjugated bilirubinemia
increased aminotransferases

Back 120

hepatocellular

Front 121

conjugated bilirubinemia
increased alk phos
next steps

Back 121

biliary obstruction

1) u/s or CT to rule out extrahebatic obstruction
2) if negative then ERCP or PTC

Front 122

AMS
ataxia
nystagmus

Back 122

wernickes

Front 123

tx for wernicke's

Back 123

thiamine

Front 124

rx for hepatic encephalopathic pt with alc withdrawal

Back 124

chlordiazepoxide
(benzos too sedating)

Front 125

fever
severe jaundice
RUQ pain

Back 125

charcot's triad
acute ascending cholangitis

Front 126

fever
severe jaundice
RUQ pain
confusion
hypotension

diagnosis
next steps

Back 126

Reynold's pentad
suppurative cholangitis

next step:
1) u/s to confirm
2) supportive and abx
3) if continues - ERCP for decompression/biliary drainage

Front 127

early satiety
abd distention
decreased weight
non tender hepatomegalyflank dulness
no icteris

next step

Back 127

suspect hepatocellular cancer

serum tumor marker and imaging
think AFP

Front 128

chronic cirrhosis
alcoholic
fatigue
abd discomfort
ascietes
maybe even hypothermic or low grade fever

next step
level to confirm

Back 128

spontaneous bacterial peritonitis

pericentesis for dx

PMN >250, + culture

Front 129

acute abd pain to back
alchoholic
tenderness and guarding
increased wbc
increased amylase,lipase

tx

Back 129

acute pancreatitis

conservative
analgesics, IVF, no POS
+- nasogastric suction

Front 130

esophageal varices, non bleeding
first step
tx

if bleeding

Back 130

screeding endoscopy
propranolol ppx, nitrates

scleropathy if bleeding

Front 131

hepatorenal syndrome rx

Back 131

octreotide
midodrine

Front 132

porcellain gallbladder
possible sequela

Back 132

chronic cholecystitis

gallbladder carcinioma

Front 133

tx for amebic vs. bacterial liver abscess

Back 133

amebic - abx
bacterial - drain and Abx

Front 134

severe janudice
high high alk phos

Back 134

obstruction of CBD

Front 135

boy
abd pain
dark urine
icteris
abd tenderness
RUYQ mass
high high bili
no virus
mild increase amylase,lipase

first step

Back 135

choledochal cyst = dilatation of biliary ducts

first step u/s leading to CT or MRI

Front 136

dilatattion of intra or extra or both hepatic biliary ducts

Back 136

choledochal cyst

Front 137

intrahepatic dilatation of bile ducts congenitally

Back 137

Caroli's syndrom

Front 138

infant
marked obstructive jaundice
acholic stools

Back 138

biliary atresia

Front 139

common cauases of conjugated
intrahebatic
extrahepatic

Back 139

intrahepatic
- obstruction due to hepatitis, drug rxn, 3rd tri, post op
- DJ
- Rotor

Extrahepatic

Front 140

increase in indirect bilirubin =

Back 140

1) increased formation (e.g., in hemolysis)
or
2) decreased conjugation (as in Gilberts)

Front 141

yellowing skin post fasting
increased indirect bili
low fat diet
stress
fever
shoulder pain
N/V

diagnosis
tx
etiology

Back 141

gilberts

tx not needed

gallstones impacted in cystic duct

Front 142

infant with severe jaundice
neuro impairment (kernicteris)
v high indirect

diagnosis
inheritance
tx

Back 142

Crigler Najjar I
AR
transplant

Front 143

lower bilirumin levels than in Crigler Najjar I
srvival to adulthood

tx

Back 143

CN I (Also AR)

tx may not be necessary

Front 144

chronic and mild hyperbilirubinemia of uncong and cong without suggestion of hemolysis

Back 144

rotors

Front 145

severe ruq pain after eating fatty foods
+ Murphys

U/S:
thickened gall bladder wall
normal CB uct
normal alk phos

next step

Back 145

acute cholecystitis

observation to scheduling chole

Front 146

when is ERCP indicated

Back 146

1) sclerosing cholangitis

2) choledocholithiasis gallstone in CBD leading to dilation

3) acute biliary pancreatitis

4) acute, suppurative ascending cholangitis not responding to tx

Front 147

use of HIDA scan

Back 147

to diagnose gallbladder obstruction

esp good for acalculous chole

Front 148

use of transhepatic gallbladder drainage

Back 148

to decompress GB in pts who are unstable or can't have surgery

Front 149

severe epigastric pain
R shoulder pain
emesis
fasted day before
just had large meal
later resolves
no fever

problem causing pain

Back 149

biliary colic 2/2 stones

viscus distention